What is ICD-10 code E78.41?

E78.41 is the ICD-10-CM diagnosis code for Elevated Lipoprotein(a). A condition where there are elevated levels of lipoprotein(a), a type of cholesterol-carrying protein in the blood that increases the risk of heart disease and stroke. E78.41 is a billable code, meaning it can be reported on a claim as a primary or secondary diagnosis when supported by documentation. E78.41 is part of the FY2026 ICD-10-CM code set published by the CMS National Center for Health Statistics and used on Medicare, Medicaid, and commercial claims in the United States.

Yes. E78.41 is a billable ICD-10-CM code that can be reported on professional and institutional claims as a primary or secondary diagnosis when the provider documentation supports the specific condition described. Billable codes in ICD-10-CM are coded to the highest level of specificity available for the documented diagnosis. E78.41 is current for fiscal year 2026 and remains in the active CMS ICD-10-CM code set published by the National Center for Health Statistics.

What is the V28 vs V24 difference for E78.41?

E78.41 does not map to a payment HCC under either the CMS-HCC V28 risk adjustment model or the older V24 model. V28 reached 100% phase-in for payment year 2026, replacing V24 which was used during the PY2024–PY2025 transition. Because neither community model rewards E78.41 with a risk adjustment factor, it contributes zero to a Medicare Advantage beneficiary's V28/V24 community RAF score in either version. It does, however, map under the Part D RxHCC model (Disorders of Fatty-Acid and Lipid Metabolism), which affects the ESRD and/or Part D (RxHCC) risk scores. Coders should check whether provider documentation supports a more specific child code that does map to a community payment HCC.

What should coders know when reporting E78.41?

Document the specific lipoprotein(a) level if available to support medical necessity This code is used when lipoprotein(a) is elevated as a standalone finding, separate from other lipid abnormalities

E78.41: Elevated Lipoprotein(a) — ICD-10

ICD-10-CM Code View

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Code lookupE78.41Effective periodFY2026 Apr Update (Apr 1-Sep 30)

FY 2026 Apr update / Endocrine, nutritional and metabolic diseases (E00-E89) / Metabolic disorders (E70-E88)

E78.41

Billable / SpecificICD-10-CMOfficial ICD-10-CMCodebook guidance

Elevated Lipoprotein(a)

A condition where there are elevated levels of lipoprotein(a), a type of cholesterol-carrying protein in the blood that increases the risk of heart disease and stroke.

Buddy Insight

Elevated Lipoprotein(a), or Lp(a), is an emerging independent risk factor for atherosclerotic cardiovascular disease and calcific aortic valve stenosis.

CMS-HCC V28

N/A

—

Not risk-adjusted for this model/period.

Not mapped

CMS-HCC V24

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ACA/HHS

N/A

—

Not risk-adjusted for this model/period.

Not mapped

ESRD/PACE

N/A

—

Not risk-adjusted for this model/period.

Not mapped

RXHCC

Mapped

HCC 47

Disorders of Fatty-Acid and L...

Not separately weighted

Code Book Path

Official

E78Disorders of lipoprotein metabolism and other lipidemias

E78.4Other hyperlipidemia

E78.41Elevated Lipoprotein(a)

Inclusion Terms

Official

Elevated Lp(a)

Excludes 2

Official

ICD-10-CM does not list Excludes 2 notes for E78.41 in this effective period.

Related Child Codes

Official

E78.49Other hyperlipidemia

Includes

Official

ICD-10-CM does not list Includes notes for E78.41 in this effective period.

Excludes 1

Official

ICD-10-CM does not list Excludes 1 notes for E78.41 in this effective period.

Code First

Official

ICD-10-CM does not list Code First sequencing instructions for E78.41 in this effective period.

Use Additional

Official

ICD-10-CM does not list Use Additional Code instructions for E78.41 in this effective period.

Code Also

Official

ICD-10-CM does not list Code Also instructions for E78.41 in this effective period.

Buddy Documentation Tip

HCC Buddy guidance

Provider documentation of elevated Lp(a) as a clinical diagnosis, not just a lab finding

Lp(a) level with units (nmol/L or mg/dL) and reference range

Cardiovascular risk assessment in context of elevated Lp(a)

Family history of premature cardiovascular disease if relevant

MEAT Support

HCC Buddy guidance

Provider documentation of elevated Lp(a) as a clinical diagnosis, not just a lab finding

Lp(a) level with units (nmol/L or mg/dL) and reference range

Cardiovascular risk assessment in context of elevated Lp(a)

Family history of premature cardiovascular disease if relevant

Audit Caution

HCC Buddy guidance

Not recognizing E78.41 as a relatively new code specifically for elevated Lp(a)

Coding elevated Lp(a) under the generic E78.49 (other hyperlipidemia) when the specific code exists

Treating Lp(a) elevation the same as LDL elevation — they have different pathophysiology and treatments

Coding from a lab result alone without provider clinical assessment and management plan

Common Mistakes

HCC Buddy guidance

E78.00 — Pure hypercholesterolemia, unspecified: LDL cholesterol elevation is distinct from Lp(a) elevation

E78.49 — Other hyperlipidemia: broader category; use E78.41 when Lp(a) is specifically elevated

E78.5 — Hyperlipidemia, unspecified: too nonspecific when Lp(a) is the documented abnormality

R78.79 — Finding of abnormal level of heavy metals in blood: incorrect category entirely

Last updated: FY2026 ICD-10-CM Apr update, Apr 1, 2026 through Sep 30, 2026. CMS-HCC V28 is 100% phased in for payment year 2026.

Is E78.41 an HCC code?

E78.41 is not in the CMS-HCC V28 or V24 community payment model, but it does map to Disorders of Fatty-Acid and Lipid Metabolism under the Part D RxHCC model.

HCC Category Mapping

RxHCCHCC 47, Disorders of Fatty-Acid and Lipid Metabolism

Not separately weighted

Each model's RAF is its CMS base weight for that model's standard population, so weights are not directly comparable across models: CMS-HCC V28 and V24 use Community, Non-Dual, Aged; ESRD uses the dialysis continuing-enrollee model; RxHCC is the Part D continuing-enrollee, non-low-income, aged weight (a larger scale than CMS-HCC). ACA/HHS has no single weight — it varies by metal level. Actual per-patient RAF contribution depends on member segment, interactions, and the model year used by the payer. V28 is the CMS-HCC model phased in over payment years 2024–2026; V24 remains in use during the transition and for historical data.

Work E78.41 in the Code Book — tabular path, V28 RAF, and MEAT checklist →

MEAT Criteria for E78.41

For E78.41to count as a valid HCC diagnosis in a given encounter, the provider's documentation must show MEAT: Monitor, Evaluate, Assess, or Treat. A diagnosis from a prior year does not carry forward automatically, it has to be re-documented and supported each calendar year.

MMonitor: signs, symptoms, disease progression, or lab trending documented in the note
EEvaluate: test results, medication response, or physical findings reviewed by the provider
AAssess: explicit mention in the assessment or plan with acknowledgment of status
TTreat: medication, referral, procedure, therapy, or counseling tied to the diagnosis

Only one of M/E/A/T is required to support the code, but the documentation must be specific enough to show that the provider actually addressed E78.41 during that encounter, not just copy-forwarded from a problem list.

Coder workflow notes

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What This Code Means

E78.41 is the ICD-10-CM diagnosis code for elevated lipoprotein(a). A condition where there are elevated levels of lipoprotein(a), a type of cholesterol-carrying protein in the blood that increases the risk of heart disease and stroke. E78.41 sits in the ICD-10-CM chapter for endocrine, nutritional and metabolic diseases (e00-e89), within the section covering metabolic disorders (e70-e88).

E78.41 is a billable ICD-10-CM code but does not map to a payment HCC under the CMS-HCC V28, V24, ESRD, or RxHCC risk adjustment models. It can be reported on Medicare Advantage encounter data submissions but it does not contribute to a beneficiary's RAF score and therefore does not affect risk-adjusted payments to the plan.

This code does not map to a CMS-HCC V28 payment category. Capture depends on documentation that supports the diagnosis; verify the HCC assignment against the current CMS mapping for the applicable payment year. Coders reviewing E78.41 should check whether additional documentation would support a more specific child code in the same hierarchy that does map to a payment HCC, capturing the correct specificity is the highest-impact RAF improvement available within accurate coding.

HCC Buddy maintains structured V28 and V24 mapping, RAF weights, and MEAT documentation criteria for E78.41 sourced directly from the CMS-HCC risk adjustment model files and the CMS ICD-10-CM code set.

Coding Tips

•Document the specific lipoprotein(a) level if available to support medical necessity
•This code is used when lipoprotein(a) is elevated as a standalone finding, separate from other lipid abnormalities

Clinical Significance

Elevated Lipoprotein(a), or Lp(a), is an emerging independent risk factor for atherosclerotic cardiovascular disease and calcific aortic valve stenosis. Lp(a) levels are largely genetically determined and not significantly affected by lifestyle modifications, making it a unique lipid biomarker requiring specific screening and targeted therapeutic approaches.

Documentation Requirements

✓Provider documentation of elevated Lp(a) as a clinical diagnosis, not just a lab finding
✓Lp(a) level with units (nmol/L or mg/dL) and reference range
✓Cardiovascular risk assessment in context of elevated Lp(a)
✓Family history of premature cardiovascular disease if relevant
✓Treatment plan: aspirin, niacin, PCSK9 inhibitors, or emerging antisense therapies
✓Screening rationale (personal or family history of atherosclerotic cardiovascular disease)

Commonly Confused Codes

•E78.00: Pure hypercholesterolemia, unspecified: LDL cholesterol elevation is distinct from Lp(a) elevation
•E78.49: Other hyperlipidemia: broader category; use E78.41 when Lp(a) is specifically elevated
•E78.5: Hyperlipidemia, unspecified: too nonspecific when Lp(a) is the documented abnormality
•R78.79: Finding of abnormal level of heavy metals in blood: incorrect category entirely

Child Codes

E78.41Elevated Lipoprotein(a)

E78.49Other hyperlipidemia

Code Hierarchy

└E78Disorders of lipoprotein metabolism and other lipidemias └E78.4Other hyperlipidemia └E78.41Elevated Lipoprotein(a)

└E78.41Elevated Lipoprotein(a)

E78.41 ICD-10-CM Code: Elevated Lipoprotein(a)

HCC Buddy Code Card

E78.41

Is E78.41 an HCC code?

HCC Category Mapping

MEAT Criteria for E78.41

Get the V28 RAF + MEAT cheat sheet

What This Code Means

Coding Tips

Clinical Significance

Documentation Requirements

Commonly Confused Codes

Child Codes

Code Hierarchy

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